Gold Shoe Step It Up Challenge and Park Prize Pursuit Registration

Register to earn a raffle ticket for the prize drawings on June 9th at 10 am at Tanglewood.  All answers are voluntary and kept strictly confidential.  This survey must be completed by June 1st to be eligible for a ticket for the June 9th Gold Shoe Step It Up Challenge.  All who register will be entered into the summer Park Prize Pursuit prize drawings.

We will send you a weekly email full of healthy tips.  We hope the health related questions below will motivate you to improve your health. The various lifestyles we lead today often threaten our long-term health. Habits and behaviors such as poor diet, smoking, lack of exercise, and not wearing seat belts are among the common factors that can cause high risks of premature death or getting ill. We'll have health screenings on June 9th and you can get a ticket for doing that too!

You must be present June 9th at Tanglewood to win Gold Shoe prizes.
P.S. Stay tuned for details on the Park Prize Pursuit lasting all summer following the Gold Shoe Step It Up Challenge.  Find clues at local parks and qualify for even more prizes!  
Be sure to click the DONE button to submit your registration.

* 1. Please tell us:

* 2. What's your email address?  If you don't have one write none and check our Facebook page every week for the newsletter.

* 3. In general, how would you rate your overall health?

* 4. What is your height in total inches? For example, if you are 5 feet and 6 inches, write 66 or if 6 feet tall you would put 72.  Please round to the nearest inch.

* 5. What is your current weight in pounds? Please round to the nearest pound.

* 6. Do you currently smoke cigarettes, or not?

* 7. About how many alcoholic drinks do you have each week?

* 8. About how many times in the average week do you engage in 30 minutes of light activity (i.e. leisurely walking, gardening, cleaning around the house)?

* 9. About how often do you eat fast food?

* 10. About how many times in the average week do you engage in 30 minutes of moderate activity (i.e. brisk walking, light bicycling)?

* 11. About how often do you eat at a restaurant?

* 12. About how many times in the average week do you engage in 30 minutes of strenuous activity (i.e. running or jogging)?

* 13. Not including juices, how often do you eat fruit per DAY? If you don’t know for certain, please provide an estimate.

* 14. How often do you use sunscreen while out in the sun?

* 15. How often do you eat vegetables per DAY? If you don’t know for certain, please provide an estimate.

* 16. How often do you wear a seatbelt when in a car?

* 17. During the past 4 weeks, how bothered did you feel by emotional problems such as feeling anxious, depressed, irritable, or sad?

* 18. When is the last time that you saw a doctor?

* 19. When is the last time that you saw a dentist?

* 20. During the past 4 weeks, how supported did you feel when you wanted or needed help from others? For example, if you felt lonely and wanted to talk to someone or got sick.

* 21. Thank you!  Click done below and you will be registered and get a prize ticket on June 9th. If you would like more information on leading a healthier life please click here (opens in new window).  Be sure to check your email Mondays for our weekly newsletter for healthy tips.     Let us know if you have any questions or comments below.

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